Provider Demographics
NPI:1710503388
Name:ANNIE'S HOME, LLC
Entity Type:Organization
Organization Name:ANNIE'S HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:MAYSON
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:602-503-9139
Mailing Address - Street 1:8517 W CHICKASAW ST.
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353
Mailing Address - Country:US
Mailing Address - Phone:602-503-9139
Mailing Address - Fax:
Practice Address - Street 1:8517 W CHICKASAW ST.
Practice Address - Street 2:
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353
Practice Address - Country:US
Practice Address - Phone:602-503-9139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health